Causes

There is no known single cause of schizophrenia. Many diseases, such as heart disease, result from an interplay of genetic, behavioral and other factors, and this may be the case for schizophrenia as well. Scientists do not yet understand all of the factors necessary to produce schizophrenia, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness.

Can It Be Inherited?
It has long been known that schizophrenia runs in families. People who have a close relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with the illness. For example, a monozygotic (identical) twin of a person with schizophrenia has the highest risk — 40 to 50 percent — of developing the illness. A child whose parent has schizophrenia has about a 10 percent chance. By comparison, the risk of schizophrenia in the general population is about 1 percent.

Scientists are studying genetic factors in schizophrenia. It appears likely that multiple genes are involved in creating a predisposition to develop the disorder. In addition, factors such as prenatal difficulties like intrauterine starvation or viral infections, perinatal complications, and various nonspecific stressors, seem to influence the development of schizophrenia. However, it is not yet understood how the genetic predisposition is transmitted, and it cannot yet be accurately predicted whether a given person will or will not develop the disorder.

Several regions of the human genome are being investigated to identify genes that may confer susceptibility for schizophrenia. The strongest evidence to date leads to chromosomes 13 and 6 but remains unconfirmed. Identification of specific genes involved in the development of schizophrenia will provide important clues into what goes wrong in the brain to produce and sustain the illness and will guide the development of new and better treatments. To learn more about the genetic basis for schizophrenia, the NIMH has established a Schizophrenia Genetics Initiative that is gathering data from a large number of families of people with the illness.

Is It Caused by a Chemical Defect in the Brain?
Basic knowledge about brain chemistry and its link to schizophrenia is expanding rapidly. Neurotransmitters, substances that allow communication between nerve cells, have long been thought to be involved in the development of schizophrenia. It is likely, although not yet certain, that the disorder is associated with some imbalance of the complex, interrelated chemical systems of the brain, perhaps involving the neurotransmitters dopamine and glutamate. This area of research is promising.

Is It Caused by a Physical Abnormality in the Brain?
There have been dramatic advances in neuroimaging technology that permit scientists to study brain structure and function in living individuals. Many studies of people with schizophrenia have found abnormalities in brain structure (for example, enlargement of the fluid-filled cavities, called the ventricles, in the interior of the brain, and decreased size of certain brain regions) or function (for example, decreased metabolic activity in certain brain regions).

It should be emphasized that these abnormalities are quite subtle and are not characteristic of all people with schizophrenia, nor do they occur only in individuals with this illness. Microscopic studies of brain tissue after death have also shown small changes in distribution or number of brain cells in people with schizophrenia. It appears that many (but probably not all) of these changes are present before an individual becomes ill, and schizophrenia may be, in part, a disorder in development of the brain.

Developmental neurobiologists funded by the National Institute of Mental Health (NIMH) have found that schizophrenia may be a developmental disorder resulting when neurons form inappropriate connections during fetal development. These errors may lie dormant until puberty, when changes in the brain that occur normally during this critical stage of maturation interact adversely with the faulty connections. This research has spurred efforts to identify prenatal factors that may have some bearing on the apparent developmental abnormality.

In other studies, investigators using brain-imaging techniques have found evidence of early biochemical changes that may precede the onset of disease symptoms, prompting examination of the neural circuits that are most likely to be involved in producing those symptoms. Meanwhile, scientists working at the molecular level are exploring the genetic basis for abnormalities in brain development and in the neurotransmitter systems regulating brain function.

Symptoms

Clinical symptoms and signs for evaluation of
psychosis for ease of understanding can be
divided into following two groups:

Positive symptoms

Negative symptoms

Positive symptoms
Called ‘positive’ since the person’s thoughts, beliefs or sensations seems to be ‘’abnormally expanded or greater’’ than normal; suggest person having lost contact from reality and of having created one’s false world.

Hallucinations: refers to perceiving any sensations in absence of a real stimulus, e.g. hearing or seeing things that are not there.

Delusion: refers to false beliefs that are held with extraordinarily conviction and are not shared by other members of the society.

Thought disorder: refers to the disorganization in thought as reflected by speech or sentences which are disjointed or cannot be understood e.g. while speaking person looses chain of thought or one thought has no connection with other.

Negative symptoms
Called ‘negative’ since they involve ‘’decrease’’ in a person’s usual experiences and functioning.
They include:

Little/ no drive to do things

Lack of energy and interest

Little display of feelings

Speaking very less

Treatments

Antipsychotics: The most common medical treatment for schizophrenia is the use of antipsychotic medication. 70% of people using medications for schizophrenia improve, and medicine can also cut the relapse rate for the disorder by half, reducing it to 40%. Classic schizophrenia medication includes Thorazine, Fluanxol, and Haloperidol. These medications are effective in treating the positive symptoms of schizophrenia. Newer “atypical” medications include Risperdal, Clozaril, and Aripiprazole. These medications are recommended for first-line treatment and are excellent at reducing negative symptoms.

Antidepressants: Antidepressants are recommended for those suffering from schizoaffective disorder. Antidepressants can successfully reduce the symptoms of depression in these patients.

Psychotherapy: Psychotherapy of some type is highly recommended for people suffering from schizophrenia. By adding behavioral treatments for schizophrenia to a medical treatment regimen, the rate of relapse is further reduced, to only 25%. A variety of types of psychotherapy are available to schizophrenics. Cognitive therapy, psychoeducation, and family therapy can all help schizophrenics deal with their symptoms and learn to operate in society. Social skills training is of great importance, in order to teach the patient specific ways to manage themselves in social situations.

Alternative Treatments
Alternative treatments for schizophrenia are available, although they are never recommended without first seeking medical treatment. They are most effective when paired with antipsychotics and administered under doctor supervision. In particular, dietary supplements have proven to have dramatic effects on the symptoms of schizophrenia.

Glycine Supplements: Glycine, an amino acid, is shown to help alleviate negative symptoms in schizophrenics by up to 24%.

Omega-3 Fatty Acids: Found in fish oils, Omega-3 fatty acids high in EPA can help to reduce positive and negative symptoms associated with schizophrenia.

Antioxidants: The antioxidants Vitamin E, Vitamin C, and Alpha Lipoic Acid show a 5 to 10% improvement in symptoms of the disorder.

Psycho-education: Discuss with the patient and family
regarding:

-The person’s ability to recover;

-The importance of continuing regular social, educational and occupational activities, as far as possible

-the suffering and problems can be reduced with treatment

-the importance of taking medication regularly;

-the right of the person to be involved in every decision that concerns his or her treatment

-Importance of staying healthy (e.g. following healthy diet, staying physically active, maintaining personal hygiene).

Vocational Rehabilitation
Actively encourage the person to resume social,educational and occupational activities as appropriate and advise family members about this.

Facilitate inclusion in economic and social activities, including socially and culturally appropriate supported employment.

Work with local agencies to explore employment or educational opportunities, based on the person’s needs and skill level.

Follow-ups

Follow up frequency:

Acute phase: Follow up once or twice weekly.

Maintenance phase: Follow up every one to three month.

Follow up assessment: During follow up visits, assess for the following:

-Level of symptoms

-Side-effects of medications

-Treatment adherence: Treatment non-adherence is common, address it

-Assess for and manage concurrent medical conditions

-Assess for the need of psychosocial interventions at each follow-up

-Maintain realistic hope and optimism during treatment

-Involvement of carers is critical during such periods

Nature of illness

-Severe level of symptoms and distress

-Suicide or risk of harm to others

-Marked violent aggressive behavior

-Catatonic symptoms

-Poor general medical status

-Refusal to accept orally (meals/ medications)

Nature of treatment

-Partial or no response to treatment

-Need to start modified electroconvulsive therapy

-Need to start clozapine

-Need of specific psychological therapies or vocational rehabilitation

Support system

-Poor social support system (e.g. homelessness)

-Family needs psycho-education about nature of illness and need of treatment